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Membership Application Form

Welcome to Pontypridd Roadents AC! Complete the form below to apply for membership. Once submitted, our membership secretary will be in touch with payment instructions.

If you'd prefer to apply by email, contact [email protected].

Don't fill this out:

Your details

First name *Last name *

Date of birth *Gender

Address *

Email *Telephone *

Emergency contact

First name *Last name *

Address *Telephone *

Membership type *

Annual membership runs from 1st April. Fees include Welsh Athletics affiliation where applicable.

Senior Membership (20+)£45Junior Membership (17–19)£352nd Claim / Associate£24

Affiliation

Are you affiliated with another club? *

Yes No

Club nameRegistration number

Health and support

Do you have any medical conditions, injuries or allergies we should be aware of when you're training with us? *

Yes No

If yes, please give details and anything a run leader should do in an emergency.

Do you consider yourself to have a disability? *

Yes No

If yes, what is the nature of your disability? Please specify (e.g. visual impairment, hearing impairment, physical disability, learning disability, multiple disability or other).

Would you like a confidential conversation with the Club Welfare Officer about any support you may need to participate in club activities? *

Yes No Prefer to discuss in person

Please note: We will only use this information to support your safe participation in club activities and, where necessary, in an emergency. Access will be restricted to appropriate club officials and run leaders. Please see our Privacy Notice for further information.

Disclaimer

I confirm that to the best of my knowledge I can participate in physical activity. I confirm that I understand that participation in this club is entirely at my own risk and I should consult my doctor if suffering from any condition that might make running injurious to my health. If I am required to seek my doctor's advice prior to commencement of any physical activity, I agree to contact my doctor and I take full responsibility for obtaining written permission before starting such activities. I understand that I am responsible for monitoring myself throughout the training sessions and that if any unusual symptoms occur, I will cease participation and inform the group leader and my doctor. I confirm that I will take every precaution possible for the safety of myself and others and act in a responsible manner. I am aware that physical activity can be hazardous and there is a risk involved. I acknowledge that I participate at my own risk and take full responsibility for my actions. I understand that I cannot hold the club or its officers liable for any loss of injury, however caused.

I have read and agree to the disclaimer above. *

Declaration

In submitting this form, I confirm that I have read, understood and agree to abide by the rules contained in the Club's Policies to include, but not limited to:

• Club Constitution
• Code of Conduct Policy
• Social Media Policy

I hereby apply to become a member of Pontypridd Roadents A.C. and confirm that I am an amateur as defined by Welsh Athletics Ltd. (By becoming a member of the club, you are automatically agreeing to the codes of practice as stated by Welsh Athletics. This relates to the codes of conduct, to the rules of UK Athletics and to adhere to all anti-doping rules and regulations.)

I have read and agree to the declaration above. *

Data protection

When you become a member of, or renew your membership with, Pontypridd Roadents A.C. you will automatically be registered as a member of Welsh Athletics. We will provide Welsh Athletics with your personal data and you will have access to this information via the online portal myATHLETICS. In addition to passing data to Welsh Athletics, the use of data is likely to include the following activities, and more: team selection and competition entry, membership and club management, marketing and club communications, funding and reporting purposes. This data will be held securely and will not be passed to anyone other than you, and any other club member with a need to access it for the club's purposes. The information held will be deleted when you cease to be a club member. Under no circumstances will the data be passed to any other person or third party (except for Welsh Athletics) unless specific consent is obtained.

Please tick the boxes below to indicate your consent.

I consent to my personal data being stored and used by Pontypridd Roadents A.C. and Welsh Athletics for membership administration as described above. * I consent to photographs taken at club events being used for club promotion (website, social media, press).